Provider Demographics
NPI:1629232160
Name:JURICA, SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:JURICA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12343 HYMEADOW DR
Mailing Address - Street 2:SUITE 2J
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1878
Mailing Address - Country:US
Mailing Address - Phone:830-992-9790
Mailing Address - Fax:
Practice Address - Street 1:12343 HYMEADOW DR
Practice Address - Street 2:SUITE 2J
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1878
Practice Address - Country:US
Practice Address - Phone:830-992-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011263111N00000X
TX12605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300022831Medicare PIN